Kidney Week

Abstract: TH-PO302

Translation of Interventional Study Findings into Clinical Guidelines for Adults Requiring Maintenance Dialysis

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Hull, Katherine Leigh, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

Katherine Leigh Hull, MBChB

• Adenwalla, Sherna F., University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

Sherna F. Adenwalla, MBChB

• Cluley, Victoria, University of Nottingham School of Sociology and Social Policy, Nottingham, United Kingdom

Victoria Cluley, PhD

• March, Daniel Scott, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

Daniel Scott March, PhD

• Graham-Brown, Matthew, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

Matthew Graham-Brown, MBChB, PhD

• Said, Rahma, University of Leicester Department of Population Health Sciences, Leicester, United Kingdom

Rahma Said, MSc

• Burton, James, University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom

James Burton, MBChB, PhD, FASN

Background

There is a substantial gap between the evidence-base from randomised controlled trials (RCTs) and the implementation within clinical care in nephrology. This study aims to understand the factors that influence the utilisation of RCT data in nephrology clinical practice guidelines for the maintenance dialysis population.

Methods

The systematic review was registered prospectively on National Institute for Health Research’s International Prospective Register of Systematic Reviews (PROSPERO, CRD42021249460). Searches were completed in MEDLINE, Embase, CINAHL, and CENTRAL. There were no limits on language or location. The search strategy was limited by publication date 01/01/2015 - 31/12/2018. Descriptive statistics are reported as frequencies with percentages and statistical testing included binomial logistic regression.

Results

7844 records were identified; 268 RCTs with 305 associated reports were eligible. None of the eligible RCTs reported a Patient and Public Involvement and Engagement statement. Twenty-two (8.2%) of the RCTs were utilised in the nephrology clinical guidelines through 24 (7.9%) associated reports. None of the RCTs included in the guidelines were unique to the peritoneal dialysis (PD) population. Binomial logistic regression modelling suggests that RCTs included in the clinical guidelines are more likely to: have clinical effectiveness as their primary purpose; report a clinical trials registration; originate from North America; have a longer follow-up time; and publish adverse event data (Table 1).

Conclusion

Nephrology clinical guidelines are not utilising the full evidence-base of RCTs, with a preference for North American led research. There is an absence of documented patient involvement. The PD population are underrepresented. Poor study design, inconsistent reporting and a lack of external validity appears to impact the utility of RCT data in guidelines.

Table 1 - Model of best fit for RCT and publication characteristics predicting presence in nephrology clinical guidelines